ABSTRACT Gender variant individuals ? that is, those whose experience of their gender doesn't match their biological sex ? are experiencing an unprecedented moment in the spotlight of American culture. However, this group is poorly understood, particularly its youth. In 2011, the Institute of Medicine published a report summarizing current knowledge about lesbian, gay, bisexual and transgender (LGBT) populations. Although a small body of research, conducted almost entirely with non-probability samples, demonstrates that transgender people experience elevated levels of victimization, suicide involvement, substance use and high risk sexual behaviors compared to cisgender people (i.e., matching biological sex and gender identity), the IOM specifically notes that research on this population is sorely lacking. The proposed research includes extensive analysis of a large, population-based sample of gender variant youth (N~1,200), takes a broad view of health influences and health care, and pairs this information with qualitative data from adolescent health care providers and youth. The goal of this mixed-methods study is to understand the health needs of gender variant youth in order to develop and test training modules to be used in medical and nursing education in a future R01 application. The study has two specific aims: 1) Analyze data from the Minnesota Student Survey (MSS), a statewide surveillance system of adolescents' health and related behaviors, which has recently been revised to include three measures regarding gender (biological sex, transgender identity, gender presentation). Analyses will focus on high risk health behaviors (i.e. substance use, sex behaviors, suicide involvement, bullying and prejudiced-based victimization), protective factors (i.e. internal assets, family support, school connection), health and health care utilization of gender variant youth, with comparisons to straight cisgender youth and youth who are cisgender and lesbian, gay, bisexual and questioning (LGBQ, with whom transgender youth are often grouped for services and resources). 2) Conduct interviews with health care providers working with adolescents and with gender variant youth to understand health care practices and needs of this population. Interviews with health care providers will include questions about their professional training regarding gender variant youth, need for resources, and comfort and competence with this topic. Interviews with gender variant youth will include questions regarding their experiences with health care professionals, information they would share with providers about their health needs, and feedback on findings from health care provider interviews.